Robert L. Quinn
Commissioner of Safety
DEPARTMENT OF SAFETY
DIVISION OF MOTOR VEHICLES
BUREAU OF TITLE AND ANTI-THEFT
23 Hazen Drive, Concord, NH 03305
TDD Access: Relay NH (7-1-1)
Elizabeth A. Bielecki
Director of Motor Vehicles
APPLICATION FOR DUPLICATE CERTIFICATE OF TITLE
I hereby make application, in accordance with the New Hampshire laws for the issuance of a duplicate certificate of title to the below described vehicle. The
original certificate has been (check one).
STOLEN LOST DESTROYED NEVER RECEIVED
CURRENT OWNER DRIVER LICENSE # OR
GOVERNMENT ID:
All * fields must be completed in full.
CURRENT CO OWNER DRIVER LICENSE # OR
GOVERNMENT ID:
PER APPLICATION $25.00
MAKE CHECK PAYABLE TO:
STATE OF NH - DMV
*1. OWNER'S NAME(S)(LAST,FIRST,MIDDLE)
*2. DATE(S) OF BIRTH
MO/DAY/YR
DO NOT WRITE IN THIS SPACE
(MUST GIVE CURRENT MAILING ADDRESS) STREET OR BOX NO.
*3. LEGAL RESIDENCE IF OTHER THAN MAILING ADDRESS
*4. VEHICLE IDENTIFICATION NUMBER
5. ODOMETER-ACTUAL MILEAGE
*11. MODEL YR.
15. TITLE NO. MV use only
16. MV use only
THIS VEHICLE IS SUBJECT TO THE FOLLOWING LIENS:
17. FIRST LIEN HOLDER'S NAME (IF NONE, WRITE N/A)
18. MOTOR VEHICLE
STATE
ZIP CODE
OWNER’S SIGNATURE(S): *READ PENALTY BELOW BEFORE SIGNING
19. OWNER'S SIGNATURE(S) OR LIENHOLDER
20. DATE SIGNED (MO/DAY/YR)
I/WE CERTIFY THAT I/WE HAVE TRANSFERRED MY/OUR INTEREST IN THE ABOVE VEHICLE AND AUTHORIZE THE TITLE TO BE MAILED TO THE LICENSED
DEALER.
DEALER NAME:__________________________________DEALER #_______________ ADDRESS _________________________________________________________
IF THE OWNER IS A CORPORATION, PARTNERSHIP OR OTHER ASSOCIATION, THE PERSON SIGNING IN BOX 19 MUST CERTIFY BELOW,
UNDER PENALTY OF PERJURY, THAT HE/SHE IS AUTHORIZED TO SIGN ON BEHALF OF THE OWNER. THIS APPLICATION IS SIGNED UNDER
PENALTY OF UNSWORN FALSIFICATION PURSUANT TO RSA 641:3.
I, _______________________________________HEREBY CERTIFY THAT I AM AN AGENT AUTHORIZED TO SIGN THIS APPLICATION ON BEHALF
INSTRUCTIONS
If the vehicle is jointly owned, both owners' signatures required.
If the vehicle model year is 1999 or older, the vehicle is Exempt and a Title may not be issued.
Even though the lien may have been previously satisfied, if the original title named a lienholder, a lien release is needed on form TDMV 20A or on
bank letterhead, indicating the lien is released and signed. See below for fax and email.
This request will permanently change your address on all DMV records (Registration, Driver, License, Title, etc.).
If you have questions, you may contact the Bureau of Title at 603-227-4150 or via email Title@dos.nh.gov or fax at 603-271-0369.
TDMV18 (Rev 05/19)
PRINT NAME
*PENALTY: A PERSON WHO, WITH FRAUDULENT INTENT, USES A FALSE OR FICTITIOUS NAME OR ADDRESS, OR MAKES A MATERIAL FALSE STATEMENT, OR FAILS TO DISCLOSE A
SECURITY INTEREST, OR CONCEALS ANY OTHER MATERIAL FACT, IN AN APPLICATION FOR A CERTIFICATE OF TITLE, OR IN ANY PROOF OR STATEMENT IN WRITING IN CONNECTION
THEREWITH, SHALL BE GUILTY OF A CLASS B FELONY IF A NATURAL PERSON, OR GUILTY OF A FELONY IF ANY OTHER PERSON, RSA 262:1,I.
OF ____________________________________________________THE OWNER NAMED IN BOX 1
PRINTED COMPANY NAME
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